Curtis moring Insurance Agency, Inc. Think CMI for all your insurance needs.
Business Insurance Coverage
 
Section One of Two
California Restaurant
Property & Liability Application
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Name of Business:
DBA:
Street:
City:
State:
Zip Code:
 
Tel. No:
Fax No:
Email Address:
Contact Name:
If more space is needed, fill out a blank sheet & attach to back
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nBusiness Property Section
Business is:
Coporation Individual Proprietor Partnership Other
If other type, specify:
       
1
   DBA:
       
2
   Risk
Location:
       
3
   Owner's
Experience:		 Total years
       
4
   Owner is:
Manager
Cook
Investor
       
5
   Has any
prior carrier:
Cancel
  
Non-Renew
If so, explain:
       
6
   Restaurant
is:
Tables
Fast Food
Other
If other type, specify:
       
7
   Hours:

Open Close
       
8
   Building:
Masonry
  
Frame/Stucco
  
Other
If other type, specify:
       
9
   Roof:
Tile/Composition
  
Wood/Shake
Other
   
If other type, specify:
       
10
   Building Age:

Years
If over 35 years, when was building
wiring & plumbing brought to code:

       
11
   Building
Sprinkler:
Partially
  
Fully
  
No
If partially, explain:
       
12
   Burglar Alarm:
Yes
 
No
Local   Central
       
13
   Parking Lot:
Owned/Ocupied by Insured
Shared with Shopping Center
Other
If other type, specify:
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14
   Describe
neighbors:
Left:
Distance:
Right:
Distance:
Back:
Distance:
     
15
   Are there residents (apartments) in the building:
     
Yes
  
No
If yes, explain:
     
16
   Total Restaurant Area:
      Sq. Footage
       
17
   Liquor:
Full Bar
Beer/Wine
None
       
18
   Entertainers:
Yes
  
No
If yes, explain:
       
19
   Dancing:
Yes
  
No
If yes, explain:
       
20
   Annual
Gross
Receipts:		 Food Liquor
     
21
   Will restaurant be closed for remodeling/construction during the policy period:
     
Yes
  
No
If yes, explain:
       
22
   Cooking
at tables:
Yes
  
No
If yes, explain:
       
23   Outside Catering:
   
Yes
  
No
     
24
   Are customers allowed access to kitchen facilities:
     
Yes
  
No
If yes, explain:
     
25
a)
 Is there an automatic suppression system (Ansl, Kidde, other)
with an automatic fuel cut off protecting all cooking areas:
     
Yes
  
No
 
b)
 Name of installing/servicing company:
     
 
c)
 Does the insured maintain a contract with a professional fuel cleaning service:
     
Yes
  
No
 
d
 Are hoods & ducts cleaned at least every 3 months:
     
Yes
  
No
 
e)
 How often are filters cleaned:
     
     
   
Curtis Moring
Insurance Agency, Inc.
 
 
License #0719355
 
   
  123 Camino de la Reina, Suite 202 East
  San Diego, CA 92108
   
 
(800) 321-0677
  p: (619) 718-7575
 
f: (619) 718-7565
   
  email:
  information
 
  This form is not an insurance policy or an insurance contract. Your agreement to these terms does not create an insurance contract or agreement. These terms must be accepted by the insurance company before there is any contract or coverage.
 
Serving California consumers since 1963. PRIVACY POLICY.
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San Diego, California 92108. Site design by SFDesign '03. All rights reserved.